Online Membership Application

Please select your membership type

Active (One Year Membership Fee: $195.00)
Affiliate (One Year Membership Fee: $39.55)
Associate (One Year Membership Fee: $60.00)

IFSO Membership

IFSO Obesity Surgery (One Year Membership Fee: $105.00)
IFSO Obesity Surgery and SOARD (One Year Membership Fee: $195.00)
IFSO Membership (non-surgeons) (One Year Membership Fee: $26.00)

None

Personal Information

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First name:
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Professional Information

Title
Hospital Affiliation
Practice Type

Medical Education

University
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Province / State
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Degrees
Year of Graduation
I am a Member of (Provincial/State Licensing Board)

Active Members

Check the procedures/treatments you perform:

	Laparoscopic Gastric Banding
	Laparoscopic BPD with Duodenal Switch
	Laparoscopic Sleeve Gastrectomy
	Open BPD with/without Duodenal Switch
	Revisional surgery
	Medical Interventions
	Behavioral Interventions
	Specialized Diets (e.g. VLCD)
Other (specify)

E-mail address

CANADA ANTI-SPAM REQUIREMENTS:

This section MUST be completed in order for the application to be processed. CABPS communicates electronically with its membership; in accordance with the Canada Anti-Spam Law, you must indicate whether you wish to receive electronic correspondence from us:

E-mail address
Electronic Correspondence	I AGREE to receive electronic correspondence I DO NOT wish to receive electronic correspondence

Principal Office/Address

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Contact Information

Preferred Correspondence	Principal Office Home
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Website

Member Directory

Payment Information

Subtotal:	$0.00
Tax on CABPS Membership:	$0.00
Total:	$0.00
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Expiration (MM/YYYY): *	/

 

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